Affordable Care Act Update: Final Regulations for 90-Day Waiting Period Released
February 21, 2014 at 11:19 am | Posted in Affordable Care Act, Compliance, Creditable Coverage, Department of Labor, Employment Law, Federal Taxes, Health and Human Services, Health Care, PPACA, Regulations | Leave a commentTags: "PPACA", 2010 Patient Protection Affordable Care Act, ACA, Affordable Care Act, Department of Health and Human Services, department of labor, essential health care benefit, health care reform, health insurance, Obamacare, Patient Protection and Affordable Care Act
On February 20th, The U.S. Departments of Labor, Treasury, and Health and Human Services published final regulations (85 pages) implementing a 90-day limit on waiting periods for health coverage. The final regulations require that no group health plan or group health insurance issuer impose a waiting period that exceeds 90 days after an employee is otherwise eligible for coverage. The rules do not require coverage be offered to any particular individual or class of individuals.
To ensure that eligibility conditions based solely on the passage of time are not used to evade the waiting period limit, the rules state that such conditions cannot exceed 90 days. Other conditions for eligibility are generally permissible, such as meeting certain sales goals, earning a certain level of commission, or successfully completing an orientation period.
Additionally, requiring employees to complete a certain number of hours before becoming eligible for coverage is generally allowed as long as the requirement is capped at 1,200 hours. The rules also address situations in which it cannot be determined that a new employee will be working full-time.
The departments are issuing a companion proposed rule that would limit the maximum duration of an otherwise permissible orientation period to one month. This proposal will be open for public comment.
A link to the final rule is here: http://www.dol.gov/opa/media/press/ebsa/20140220-redfeg1.pdf.
U.S. Supreme Court to Address Constitutionality of Affordable Care Act’s Contraception Mandate On Private Employers
November 26, 2013 at 1:04 pm | Posted in Affordable Care Act, Compliance, Creditable Coverage, Essential Health Benefits, Federal Laws, Health Care, Medical, PPACA, Regulations, Wellness | Leave a commentTags: "PPACA", ACA, Affordable Care Act, Circuit Court of Appeals, constitutional, contraceptive mandate, Creditable Coverage, essential health care benefit, health care reform, health insurance, Health policy, Insurance, Obamacare, Patient Protection Affordable Care Act, Supreme Court, United States Supreme Court
The Supreme Court announced today that it will accept for hearing and decision the constitutional challenge to the Affordable Care Act’s (ACA) contraception mandate as it applies to private employers who have a religious objection to the mandate. The contraception mandate is part of one of the ten required health essential benefits (women’s preventive health services) required of health plans under ACA.
There is currently a disagreement among the federal Circuit Courts of Appeals as to its constitutionality. It is reported that the hearing will be this spring.
Treasury Department To Congress: Cannot Foresee Additional Delays in Roll Out of the Affordable Care Act
July 19, 2013 at 9:46 am | Posted in Affordable Care Act, Creditable Coverage, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, Medical, PPACA, Regulations | Leave a commentTags: "PPACA", ACA, health care reform, health insurance, Health Insurance Exchange, Health insurance mandate, Health Insurance Marketplace, Health policy, Obamacare, Patient Protection and Affordable Care Act
According to the July 19th edition of HealthWatch
A top Treasury official on Thursday suggested that his department has no current plans to delay additional provisions of the ObamaCare. J. Mark Iwry, Treasury’s deputy assistant secretary for retirement and health policy, told lawmakers that the employer mandate is the only policy that has been considered for deferral. “We don’t have any specific provision that we’ve identified for which we would give some relief,” Iwry said in witness testimony.
A senior adviser to the Treasury secretary, Iwry appeared before the House Energy and Commerce subcommittee on Oversight and Investigations on Thursday. It was his second time testifying on the employer mandate delay in one week.
Republicans grilled Iwry on the legal justification for the administration’s decision to push the policy’s enactment to 2015. GOP lawmakers also urged him to explain whether Treasury has the ability to also delay the individual mandate to buy health insurance. Iwry replied that his department had not conducted the necessary analysis to answer that question.
The House on Wednesday passed legislation that would delay the rule that most individuals carry health coverage starting Jan. 1. Republicans and some Democrats argued that individuals should not be required to comply next year if businesses will not be required to provide insurance until 2015.
On Thursday, the GOP pressured Iwry to explain why his department has not chosen to delay the individual mandate. Iwry said that Treasury hasn’t heard a reason to defer the policy that is “comparable” to the reasons cited for delaying the employer mandate. Businesses had called for more flexibility in order to comply with elaborate reporting requirements under the rule.
In a moment of rage, Energy and Commerce Vice Chairman Marsha Blackburn (R-Tenn.) said the administration was “trying to cater to big business but not to hardworking taxpayers.”
Rep. Diana DeGette (Colo.), the subcommittee’s top Democrat, cited one major reason not to delay the individual mandate — the move would cause premiums to spike. “If you delay the individual mandate for a year, many, many millions of Americans … won’t be able to get affordable health insurance through these [insurance] exchanges,” DeGette said.
Federal Government Says “NO!” to the Idea that Stand Alone HRAs and/or Defined Benefit Contributions Can Take the Place of a Health Insurance Policy for Compliance Purposes
February 26, 2013 at 1:37 pm | Posted in Affordable Care Act, Creditable Coverage, Department of Labor, Federal Laws, Health and Human Services, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, Health Reimbursement Account | Leave a commentTags: ACA, Creditable Coverage, Department of Health and Human Services, department of labor, essential health care benefit, health insurance, Health Insurance Exchange, Health Insurance Marketplace, HHS, HRA, pay or play
The Department of Labor (DOL); the Department of Health and Human Services, and the Treasury Department (collectively “the Agencies”) recently released “FAQs About Affordable Care Implementation Part XI” (FAQs). In regards to HRAs, the sum and substance of the FAQs is that employers are on notice that they cannot avoid the new federal group health plan mandates, and the “pay or play” shared responsibility penalties in particular, if they think they can simply replace group health insurance coverage with a “stand alone” HRA or a defined benefit contribution that would allow the employee to purchase health insurance through a Health Insurance Marketplace. In short, giving the employee a sum of cash or credit through an HRA to purchase health insurance on a Marketplace is not the equivalent of providing compliant group health insurance coverage sponsored by an employer.
The key issue that keeps stand alone HRAs and the defined benefit concept on the sideline for compliance purposes is the Affordable Care Act’s prohibition against annual or lifetime limits on essential health benefits (otherwise known as PHS Act Section 2711). Conversely, an HRA that is integrated with other health coverage as part of a group health plan that does not have annual or lifetime limits on essential benefits does not create non-compliance exposure, since the combined benefits of the two components (the HRA and group health insurance) satisfy compliance requirements. The key FAQS are as follows:
Q: May an HRA used to purchase coverage on the individual market be considered integrated with that individual market coverage and therefore satisfy the requirements of PHS Act section 2711?
No. The Departments intend to issue guidance providing that for purposes of PHS Act section 2711, an employer-sponsored HRA cannot be integrated with individual market coverage or with an employer plan that provides coverage through individual policies and therefore will violate PHS Act section 2711.
Q: If an employee is offered coverage that satisfies PHS Act section 2711 but does not enroll in that coverage, may an HRA provided to that employee be considered integrated with the coverage and therefore satisfy the requirements of PHS Act section 2711?
No. The Departments intend to issue guidance under PHS Act section 2711 providing that an employer-sponsored HRA may be treated as integrated with other coverage only if the employee receiving the HRA is actually enrolled in that coverage. Any HRA that credits additional amounts to an individual when the individual is not enrolled in primary coverage meeting the requirements of PHS Act section 2711 provided by the employer will fail to comply with PHS Act section 2711.
Q: How will amounts that are credited or made available under HRAs under terms that were in effect prior to January 1, 2014, be treated?
The Departments anticipate that future guidance will provide that, whether or not an HRA is integrated with other group health plan coverage, unused amounts credited before January 1, 2014, consisting of amounts credited before January 1, 2013 and amounts that are credited in 2013 under the terms of an HRA as in effect on January 1, 2013 may be used after December 31, 2013 to reimburse medical expenses in accordance with those terms without causing the HRA to fail to comply with PHS Act section 2711. If the HRA terms in effect on January 1, 2013, did not prescribe a set amount or amounts to be credited during 2013 or the timing for crediting such amounts, then the amounts credited may not exceed those credited for 2012 and may not be credited at a faster rate than the rate that applied during 2012.
A link to the FAQs can be found here: http://www.dol.gov/ebsa/pdf/faq-aca11.pdf
Employer’s Prescription Drug Plan Creditable Disclosure Requirement to CMS – Nothing has Changed
October 18, 2011 at 10:34 am | Posted in CMS, Creditable Coverage, Prescription | Leave a commentTags: CMS, Creditable Coverage, health insurance, Prescription Drug Plan
In September we emailed a client alert announcing the new October 15thdeadline for employer plan sponsors to distribute the required annual Medicare Part D Creditable Coverage Notices to their affected employees, retirees, and their dependents.
We received a few calls from clients inquiring about the date for employer plan sponsors to complete the Online Disclosure requirement to the Centers for Medicare and Medicaid Services (CMS) regarding the creditable or non-creditable status of their prospective group health plan’s prescription drug program. The date of the Online Disclosure requirement has not changed. Generally, disclosure of the plan’s prescription drug creditable status remains due within 60 days of the beginning of the Plan year.
Examples of reporting deadlines:
| Plan Year Begins | Online Due Date to Report to CMS |
| January 1 | March 1 |
| February 1 | April 1 |
| March 1 | May 1 |
| April 1 | June 1 |
| May 1 | July 1 |
| June 1 | August 1 |
| July 1 | September 1 |
| August 1 | October 1 |
| September 1 | November 1 |
| October 1 | December 1 |
| November 1 | January 1 |
| December 1 | February 1 |
The only exceptions to the above Online Disclosure requirement are if: (1) the prescription drug program is terminated, or (2) the prescription drug program loses its creditable coverage status. If either of those events were to occur, the employer plan sponsor must provide Online Disclosure to CMS within 30 days of the event’s occurrence.
As always, we welcome the chance to answer any questions about these two distinct employer plan sponsor requirements and deadlines.
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